Tuesday, January 27, 2015

While at Pete’s
Coffee to write my bi-monthly blog I ran into another regular who occasionally
hangs out at Pete’s. Vandana is a professor at Loyola University.She is an expert in the psychology of
learning.While we were talking I
started to bemoan my struggles to educate people about prostate cancer. One of
the biggest bugaboos I face is how people overestimate their grasp of the
prostate cancer situation. Once I verbalized my complaint, Vandana immediately
proposed I create a basic test of prostate cancer knowledge so men could
self-assess their level of knowledge.Thanks
Vandana!

1.Which
of the following is NOT a Prostate Cancer Staging System?

a.D’Amico

b.AJCC

c.Whitmore-Jewett

d.Gleason

2.Seed
implant radiation compared to surgery causes:

a.More
erectile dysfunction

b.More
incontinence

c.More
urinary symptoms

d.Lower
cure rates

3.Men
with Gleason Score:

a.Less
than 7 never metastasize

b.Over
7 always metastasize

c.Of4 or less have undergone surgery

d.Both
a and c are correct

4.Which
of the following is true about robotic surgery compared to standard surgery?

Tuesday, January 20, 2015

BY RALPH BLUMUnsolicited Advice from Survivors for the Newly Diagnosed

In 2014, approximately 233,000 men in the U.S. were
told they had prostate cancer and to many of them it sounded at best, like the
end of their sex life, and at worst like a death threat. In reality, the
majority of them turned out to have an indolent form of the disease that was
not life threatening and could safely be monitored without any immediate
treatment.

Having said that, a diagnosis of prostate cancer is
not a walk in the park. Just when you are most vulnerable you are obliged to
confront so much complex and conflicting information that to say it leaves you
reeling would be an understatement. So your first and most important decision
is not to make a pressured decision, not to rush the treatment selection
process or allow anyone else—including any doctors you consult—to rush you into
undergoing an irreversible treatment until the shock has worn off and you have
had time to carefully analyze all the data that applies to your particular
case.

The first step after being diagnosed is to understand
the concepts of staging and grading. The grade of your cancer will tell you how
aggressive the cancer cells are. The stage tells you how extensive or advanced
the cancer is. This information, together with your PSA level, will help
determine your prostate cancer’s risk factor—whether you are in the low-risk,
intermediate-risk, or high-risk category.

If your cancer is low-risk it can be safely monitored
with “active surveillance” and does not require any immediate treatment.
If you are in the intermediate-risk category, you have many treatment choices,
and in order to make the best decision you will need to get opinions from
specialists with state-of-the-art knowledge.

You will already have seen a urologist who, if you are
a candidate for surgery, is likely to have recommended a prostatectomy. If this
is the case, it is essential to ask him the tough questions: What are the
risks? How many prostatectomies has he performed overall and how many has he
done in the past twelve months? Does he perform nerve-sparing surgery, and if
so what is his success rate with preservation of potency and continence? And if
you are over seventy, please consider prioritizing almost any other treatment option ahead of going through a major surgical procedure.

Before making a treatment decision you should consult
a radiation oncologist about brachytherapy (radioactive seed implantation), and
IMRT (Intensity Modulated Radiation Therapy), a precisely targeted type of
radiation that delivers high doses to the prostate without damaging surrounding
organs. In my opinion both these options are at least as effective as surgery
at curing the disease and both are associated with significantly lower risk of
long-term toxicity.

You should also consult a medical oncologist about
hormone therapy, a treatment that blocks the male hormone testosterone and
significantly slows the spread of the cancer, often for years. Hormone therapy
does not promise a cure, but it is a viable, non-invasive alternative to
surgery, an effective delaying action. A medical oncologist is a good doctor to
consult with as they have no vested interest in either surgery or radiation and
can often be helpful in sorting out the conflicting opinions you likely have
heard.

If your cancer is in
the high-risk category you will usually need two or more different kinds of
treatment—probably hormone therapy plus radiation. Some centers even may
mention chemotherapy such as commonly done for patients with colon cancer or
for women with breast cancer. And there
are many new treatment methods in the pipeline, so even if your cancer is
aggressive, you are not looking at an imminent death threat.

So do your research
and take your choice. And always remember: Prostate cancer is about the best
possible cancer to deal with.

Tuesday, January 13, 2015

Yesterday I sat down with a new patient, Sam, a
charming man who, unfortunately, was just found to have a prostate nodule
and a PSA of 50. When I asked Sam why he had not visited a doctor for over 10
years or undergone any PSA testing, he responded, “I have always enjoyed
perfect health. Why see a doctor?” Sounds sort of like a stupid response, but
judging by his healthy appearance, (looking more like a 70 year old than an 80
year old), one would have to say that until now his policy has been pretty
successful.However, if Sam was going to participate intelligently
in further discussions about the selection of optimal treatment, his prostate
cancer knowledge would need a major upgrade. Since my instruction had to begin
at a very elementary level, I thought I would use this blog to share the main
themes of our almost two-hour meeting together.Focusing on the basic first steps seems an appropriate theme for this,
my first blog of the New Year.Not All Cancers Are the SameMany patients introduced into the cancer world fail to
understand that lung cancer, breast cancer, brain cancer and prostate cancer
are each a distinct illness, each with more differences than similarities.
These different cancers are as different as kidney stone disease is different
from pneumonia. Therefore, preconceived notions coming from personal
experiences with one type of cancer occurring in family members or friends are
frequently misleading.Prostate Cancers are a Mixed BagIt’s fairly easy to see why dissimilar cancer types,
such as bladder cancer and skin cancer for example, behave differently; it may
be harder to understand that prostate cancer itself comes in many different and
distinct subtypes. Part of this varied behavior can be explained by the disease
stage: No one is surprised by the fact that cancer diagnosed at an early stage
has a different outlook compared to cancer diagnosed after it has metastasized.However, beyond the issue of variable stage, when
comparing two different prostate cancers of exactly the same stage, what we
call “prostate cancer” can be extremely variable. Consider the following: In
2014, 70,000 men were diagnosed with a type of prostate cancer considered to be
so harmless that experts universally agree it is best managed with active
surveillance only. However, at the other extreme, also in 2014, a very
different type of prostate cancer led directly to 28,000 deaths.Prostate Cancer in the Bone is Not Bone CancerA common misconception that needs to be rectified is
that cancer that originates in the bone, i.e bone cancer, is a totally
different entity than prostate cancer that has spread to the bone. Primary bone
cancer grows quickly, often spreads to the lungs and does not respond to
hormones. Prostate cancer that spreads to the bone tends to grow much more
slowly, only rarely spreads to the lung and usually regresses radically with
hormone therapy. Prostate cancer in the bone and primary bone cancer are two
separate and distinct illnesses that should not be confused with each other.Doctors and Patients, the Human FactorThe human factor further complicates the selection of
optimal treatment. Doctors who treat prostate cancer come from different
schools of thought. Not only are urologists, who are surgeons, trained differently
from radiation specialists, the true cancer specialists, the medical
oncologists, are practically never involved with early-stage prostate cancer.
Differences among patients—age, fitness, prostate size for example—can also
radically influence treatment selection.Sam’s SituationWith a PSA of 50, Sam is going to need a bone scan. He
may have already developed metastases. His initial color Doppler ultrasound
shows a rather vascular tumor (about an inch and a half long) with some early
extra-capsular spread. A targeted biopsy, a single core of the tumor, is
scheduled for next week and will let us know the Gleason score.If the scans turn out to be clear, and if Sam was ten
years younger, radiation and hormone therapy would give him the best chance for
cure. But in an 80-year-old, the possible side effects that can result are more
problematic. Also, we don’t know anything yet about the pace of his disease. Might
it be feasible for Sam monitor to the situation for a while? Alternatively, radiation
alone or mild hormonal therapy alone (with Casodex) could be considered. Sam
and his wife left our meeting with a copy of Invasion of the Prostate Snatchers promising to read it in
preparation for our next meeting.

Tuesday, January 6, 2015

BY RALPH BLUMWhile studies demonstrate that the new gold standard
for detection of clinically significant prostate cancer with a high degree of
certainty is a combination of systematic and MRI targeted biopsies, the practicality
of this approach still poses problems.

Mark has written many times about the growing pains
involved in the common sense use of this sophisticated technology, and also its
tremendous potential to finally help distinguish men with non-aggressive cancer
who do not need treatment from those with aggressive disease who do.

Making this technology available to every man with
prostate cancer who would benefit from it is problematic for one main
reason—the process is not very available due to the relatively few centers of
excellence that have access both to the technology, and to the highly skilled
uro-radiologists capable of reading the MRI scans with accuracy.

Prostate cancer affects men in many different ways.
Its management is complicated by extremely variable behavior patterns ranging
from slow-growing and insignificant to rapidly growing and life-threatening.
Sometimes an abnormal PSA suggests cancer but none is found at biopsy.
Sometimes a man who is thought to be a good candidate for surgery will turn out
to have cancer that cannot be effectively treated surgically. Other times a
decision has to be made whether to treat what appears to be a very small amount
of cancer and risk the inevitable side effects. All of these are issues where
prostate MRI is of value.

The biggest challenge in prostate cancer treatment is
to try to find all the cancer, but treat only that cancer which is aggressive.
Multiparametric MRI scans can help identify areas in the prostate that are
suspicious for aggressive cancer that can be missed by biopsy. They also happen
to be safer, minimally invasive, and less uncomfortable!

The main reason that Mark and I wrote our book—Invasion of the Prostate Snatchers—was to try to prevent the exorbitant number of
biopsies performed every year in the United States leading to immediate radical
treatment that in many cases was totally unnecessary.

There is no doubt that advances in MRI technology
could dramatically curb the number of biopsies performed and reduce unnecessary
treatment of non-life-threatening cancers.
From
my own experience of co-existing with prostate for over 20
years cancer,
I remain conservative when it comes to invasive treatment.

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PROSTATE SNATCHER VIDEOS

MARK SCHOLZ, MD

Mark Scholz, MD is board certified in medical oncology and internal medicine. He has been treating men with prostate cancer exclusively since 1995. He is the Medical Director of Prostate Oncology Specialists, Inc., and Executive Director of the Prostate Cancer Research Institute. He is an acknowledged expert on management and treatment for prostate cancer using hormone intervention, immunotherapy, chemotherapy and angiogenesis as well as vitamin, herbal and other forms of lifestyle counseling. His affiliations include St. John's Health Center, Marina del Rey Hospital and others. Dr. Scholz also served as an associate clinical professor in the department of Oncology at USC School of Medicine. Dr. Scholz volunteers for the Internet list “Patient to Physician,” found via Resources at www.pcri.org . You may also find current posts on twitter. www.twitter.com/markscholzmd

RALPH H. BLUM

Ralph H. Blum is a cultural anthropologist and author, graduated Phi Beta Kappa from Harvard University with a degree in Russian Studies. His reporting from the Soviet Union, the first of its kind for The New Yorker (1961—1965), included two three-part series on Russian cultural life. He has written for various magazines, among them Reader’s Digest, Cosmopolitan, and Vogue. Blum has published three novels and five nonfiction books. He has been living with prostate cancer, without radical intervention, for twenty years.

PROSTATE ONCOLOGY SPECIALISTS

Established in 1995, Prostate Oncology Specialists has earned national acclaim for its comprehensive approach to prostate cancer prevention and management. Under the direction of Medical Director Mark Scholz, M.D., Prostate Oncology Specialists employs a highly skilled team of physicians trained in oncology, radiology, hematology, and internal medicine who treat all stages of prostate cancer. Prostate Oncology Specialists are not wedded to any single therapy for prostate cancer, but rather advocate the exploration of treatment options that are customized and tailored to the unique needs of each individual patient. Treatments employed include active surveillance, testosterone deprivation, partial cryotherapy, seed implantation, intensity-modulated radiation, and surgery. Prostate Oncology Specialists’ ongoing mission is to uncover new medical breakthroughs in the treatment and management of prostate cancer.

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